Path - Joints

Question 1

compare age and speed of onset between RA and OA

Answer 1

RA: can happen at any age, develops reapidly within weeks to months

OA: usually later in life, slowly develops over years

Question 2

compare distribution and joints affected between RA and OA

Answer 2

RA: symmetrical, small joints of hands and feet

OA: initially asymmetrical mono-arthritis –> poly-arthritis, weight bearing joints

Question 3

compare duration of morning stiffness between RA and OA

Answer 3

RA: stiffness worse in the morning and lasts > 1 hour

OA: stiffness lasts < 1 hour and worse at the end of the day

Question 4

compare systemic sx between RA and OA

Answer 4

RA: fatigue, fever, night sweats

OA: none

Question 5

what conditions can cause secondary osteoarthritis

Answer 5

• DM
• hemochromatosis
• thyroid dz
• acromegaly
• charcot joints
• obesity
• trauma

Question 6

in the hand, what joints are affected by OA

Answer 6

PIP, DIP

Question 7

compare bouchard’s nodes and heberden’s nodes

Answer 7

bouchards: on the PIP

heberden’s: on the DIP (closest to fingernail)

Question 8

compare changes to the joint space between RA and OA

Answer 8

RA: inflammation, pannus of synovium, fibrosing anklylosis

OA: thinned and fibrillated cartilage, no ankylosis, subchondral CYST, osteophytes

Question 9

the presence of what antibodies support the diagnosis of RA if elevated?

Answer 9

anti-cyclic citrullinated peptide (CCP) antibodies

Question 10

describe the changes that can be seen in the hands seen in RA

Answer 10

1) boutonniere (hyperextension of DIP, flexion of PIP)
2) swan-neck (hyperextension of PIP, flexion of DIP)
3) ulnar deviation of fingers
4) radial deviation of wrist

Question 11

list the dz processes characterized as seronegative spondyloarthropathies

Answer 11

1) ankylosing spondylitis
2) reactive arthritis
3) enteritis associated arthritis
4) psoriatic arthritis

Question 12

HLA-B27 is associated with what dz processes

Answer 12

ankylosing spondylitis

reactive arthritis

psoriatic arthritis

Question 13

triad of symptoms with reactive arthritis

Answer 13

arthritis, urethritis/cervicitis/ conjuctivities

can’t see, can’t pee, can’t climb a tree

Question 14

what organisms cause enteritis associated arthritis

Answer 14

yersinia, salmonella, shigella, campylobacter

Question 15

“pencil in cup” deformity on x-ray is associated with what dz process

Answer 15

psoriatic arthritis

Question 16

what changes can occur in the nails of patients with psoriatic arthritis

Answer 16

nails can turn thick, rough, rigid, discolor, and develop pits

Question 17

suppurative arthritis in pts less than 2 years old is most likely caused by what organism?

in older kids and adults?

Answer 17

<2 yo: H. influenza

older kids and adults: s. aureus and gonococcus

Question 18

causes of viral suppurative arthritis

Answer 18

HIV, HBV, HCV, EBV, parvo B19, rubella

Question 19

causes of secondary gout

Answer 19

• increased nucleic acid turnover (leukemia)
• chronic renal dz
• congenital (Lesch-Nyhan, HGPRT deficiency)